Laboratory results show sodium 139 mEq/L, potassium 5.6 mEq/L, chloride 103 mEq/L, and glucose 106 mg/dL in a patient on digoxin. What is the priority action?

• A. Withhold the daily dose until the following day
• B. Withhold the dose and report the potassium level
• C. Give the digoxin with a salty snack
• D. Give the digoxin with extra fluids to dilute the sodium level

Answer: (B)

Potassium levels influence how digoxin affects the heart. When a patient on digoxin has hyperkalemia, it can signal digoxin toxicity or an increased risk of it, because the digoxin effect is closely tied to cellular potassium handling. The priority action is to withhold the digoxin dose and report the elevated potassium to the prescriber so they can evaluate for toxicity, adjust therapy, and order appropriate testing (such as a digoxin level and repeat electrolytes).

Giving the drug with a salty snack or extra fluids doesn’t address the dangerous electrolyte change and could worsen the situation, and simply withholding until tomorrow wouldn’t acknowledge the urgent warning that hyperkalemia represents in this context. While awaiting orders, monitor the patient’s heart rate and rhythm and watch for signs of digoxin toxicity (nausea, vomiting, confusion, vision changes, or bradycardia).